Summary
Background
The DIEAP flap has gained popularity for breast reconstruction worldwide. Despite
DIEAP flap arterial anatomy being well known, venous congestion is still an important
complication and the literature on DIEAP flap venous anatomy is lacking. Venous drainage
is less predictable and research on venous perforators is of increasing interest.
The aim of this study was to investigate the anatomical distribution, diameters and
relationships between arterial and venous perforators and their source vessels using
Duplex ultrasonography, in order to evaluate the potential benefits of pre-operative
evaluation of DIEAP flap venous perforators.
Methods
Prospectively, 140 patients undergoing DIEAP flap breast reconstruction, were pre-operatively
assessed using Duplex ultrasonography for location and diameter of arterial and venous
perforators, DIEA, DIEV, and SIEV. Perforators were plotted laterally and inferiorly
from the umbilicus. Means were compared using t-tests. Pearson's correlation coefficients were calculated.
Results
We identified 702 arterial and 355 venous perforators in 280 lower hemi-abdomens.
No venous perforators were identified in 9 (6.5%) patients; none on the right in 25
(17.9%) and none on the left in 36 (25.7%). Venous perforators were larger on the
right (p = 0.031) but DIEV and SIEV diameters were not statistically different on either sides.
The diameters of DIEA, DIEV, perforating arteries and veins were correlated, but unrelated
to the diameter of the SIEV. When a medium/large perforator vein is identified first,
there is a 93.5% chance of finding an associated medium/large perforator artery; this
reduces to 69.8% when a medium/large perforator artery is first identified.
Conclusions
There is no correlation between the sizes of perforator veins and DIEV, and the size
of the SIEV. Our data suggests that first identifying a medium/large venous perforator
increases the chances of finding a better suitable perforator complex. Pre-operative
evaluation of venous perforators may be of great interest for its potential clinical
benefits.
Keywords
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Article info
Publication history
Published online: March 19, 2012
Accepted:
February 29,
2012
Received:
November 27,
2011
Footnotes
☆This paper has been presented in part at the 12th Annual International Perforator Course, Coimbatore, India, September 10–13, 2008, and in its final version at the Annual Winter Meeting of the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS), London, UK, December 1–3, 2010 and at the 22nd Annual Meeting of the European Association of Plastic Surgeons (EURAPS), Mykonos, Greece, June 2–4, 2011.
Identification
Copyright
© 2012 Published by Elsevier Inc.
